Which physical therapist after knee surgery?

The 3 knee surgeries for which physical therapy is most common

In this article, I discuss physical therapy sessions following any type of knee surgery.

Here are (based on my own professional statistics) the three types of operations most commonly seen in rehabilitation:

Knee arthroscopy: for osteoarthritis, meniscus issues, stiffness, cartilage problems, etc.

This is a “half” operation as it is performed in a non-invasive manner, without opening the knee.

Anterior cruciate ligament (ACL) reconstruction: following a partial or complete rupture, often due to sports-related injuries.

Rehabilitation for ACL can also be done without surgery.

Total or partial knee replacement surgery: most commonly due to knee osteoarthritis.

There are, of course, many other types of knee surgeries, but these are the three surgical procedures that I have encountered most frequently in physical therapy.

Can you go to a rehabilitation center after knee surgery?

Each country has its regulations regarding access to rehabilitation centers. I’ll focus on the United States since the majority of my english readership is from there.

Public and private rehabilitation centers in the United States are often covered by health insurance, which enables financial coverage.

However, they cannot accept “just anyone.”

Currently, except for exceptions (complications, multiple pathologies, or high-level athletes), stays in rehabilitation centers are not always covered for knee arthroscopies, total or unicompartmental knee replacements, and anterior cruciate ligament (ACL) surgeries.

That’s the theory. In practice, there are many exceptions.

Typically, patients go to rehabilitation centers directly from the hospital. It’s the hospital that requests placements at various rehabilitation facilities through software that centralizes this process.

Rehabilitation centers respond with either a yes or no.

Finally, is rehabilitation center really better? I have worked in centers, hospitals, and in private practice, and I have worked with individuals who have undergone knee surgery each time.

I don’t believe that staying in a rehabilitation center leads to better recovery. I have never observed it, and studies on the subject (including teleconsultation in the aftermath of knee replacement surgery) also do not suggest that recovery is better.

For me, the rehabilitation center is mainly useful for its hotel aspect: you don’t have to manage daily tasks, household chores. And you always have someone to ask questions, to reassure you.

But it doesn’t seem to have an impact on the quality of recovery afterward.

Can you have physical therapy sessions at home for the knee?

Yes, absolutely. In the first few days after knee surgery, it’s often difficult to walk long distances. Often, driving isn’t possible either, and even being a passenger in a car can be uncomfortable.

Your physical therapist can make house calls even if it’s not explicitly stated on the prescription, and it will be reimbursed in the same way as sessions in the clinic, provided, of course, that your physiotherapist offers this service.

You can start physical therapy sessions at home and then transition to a clinic. This is what most patients I treated for knee replacement surgery (TKR) or anterior cruciate ligament (ACL) tears did.

When to start rehabilitation sessions?

People who start rehabilitation within two weeks of knee replacement surgery recover better than others (Masaracchio 2017). This is known as early rehabilitation.

You typically have a physical therapist visit you at the hospital every weekday. Then it’s advisable to continue with at least one session per week under private physiotherapy supervision.

And what about other knee surgeries?

If you have a prescription for physical therapy sessions, I recommend scheduling at least one appointment quickly with a physical therapist or physiotherapist, even if you’re not allowed to put weight on the operated leg. Your physical therapist can assess what you can or cannot do during this non-weight-bearing period.

After knee arthroscopy, some surgeons recommend not starting physical therapy until two weeks later. Personally, I find it more useful to have a physical therapy assessment during this period to determine what you can or cannot do.

If you don’t have a prescription for physical therapy sessions and you think you need the advice of a physical therapist, some physical therapists can treat you without a prescription or referral—it’s not common yet, but it’s growing.

Otherwise, you can discuss the matter with your general practitioner.

How long should you have physical therapy sessions after knee surgery?

It’s very difficult to predict the number of sessions you’ll need.

Some people who have undergone knee replacement surgery may find that only about ten sessions suffice, while others feel the need for several months of rehabilitation.

After knee arthroscopy, physical therapy sessions are not always necessary.

For ACL reconstruction, the physical therapy follow-up is often longer, but it can be as simple as once a week or even less frequently, with self-rehabilitation alongside.

It’s up to you to adjust this with your physical therapist based on the difficulties you encounter and whether you desire supervision or not.

Can you do knee rehabilitation on your own?

If you feel reassured, have no concerns, and see how to regain knee flexibility and resume daily activities without the supervision of a physical therapist, then skipping physical therapy is an option!

However, in the aftermath of knee replacement surgery, I believe it’s quite challenging to entirely forgo a physical therapist, at least for a few sessions. This surgery has the most data regarding the benefits of physical therapy compared to doing nothing.

The same rationale applies to anterior cruciate ligament surgery or other significant knee surgeries.

However, I’ve encountered many people who skipped physical therapy after knee arthroscopy without apparent issues.

This is based on my experience: I haven’t found literature data indicating whether rehabilitation is essential or optional after knee arthroscopy.

Are there physical therapists specialized in knees?

All physiotherapists are trained from their initial education to provide rehabilitation for all knee-related issues.

You can make an appointment with any physical therapist; it’s highly likely that they are accustomed to supervising rehabilitation for the type of problem you’ve had, even if they are generalists.

In larger cities, some physiotherapists specialize, for example, in sports physiotherapy. However, specialization in a particular joint is rare.

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Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !

If you feel the need to learn more about the recovery period after a knee replacement, I wrote this guide in eBook format:

…

You may also like:

• What is the Recovery Time After Knee Arthroscopy?
• How to Relieve Pain After Knee Replacement?
• Main Causes of Hot & Swollen Knee

 📚 SOURCES

Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS One. 2017;12(6):e0178295. Published 2017 Jun 2. doi:10.1371/journal.pone.0178295

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